Provider First Line Business Practice Location Address:
4535 WASHBURN AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55412-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-522-3945
Provider Business Practice Location Address Fax Number:
612-522-5124
Provider Enumeration Date:
10/17/2006